An approach to the treatment of irritable bowel syndrome

Editor’s note: Dr. Paul Donohue’s column, long a popular feature in the Sarasota Herald-Tribune, now has an online home, as well. Check out the medical questions and answers Mondays through Fridays on Health + Fitness. CLICK HERE TO READ MORE DR. DONOHUE COLUMNS.

DEAR DR. DONOHUE: I am a relatively healthy 81-year-old man who has recently been diagnosed with irritable bowel syndrome. I find it strange that a sudden change in my bowel habits occurred four months ago and still continues much of the time. My stools are loose and covered with mucus. I have to take frequent visits to the bathroom. I feel bloated.

Dr. Donohue

Is it unusual for someone of my age to have such a sudden occurrence of IBS? -- S.F.

ANSWER: The young, the old and the in-betweens can develop irritable bowel syndrome. The majority of patients fall between the ages of 30 and 50, and women patients outnumber men by a factor of two to one. You are not the usual candidate for IBS.

Experts have devised criteria to permit a firm diagnosis of this illness. One criterion is recurrent abdominal pain or discomfort for at least three days a month for the past three months. The second is a change in stool frequency, either more than three movements a day or fewer than three movements a week. The third criterion is improvement in symptoms after a bowel movement. And the fourth is a change in the appearance of the stool, either liquid or very soft, or rock-hard. So people with IBS have either diarrhea or constipation.

Bloating is another common sign. It lessens if you avoid gas-producing foods like beans, onions, celery, carrots, raisins, bananas, prunes, Brussels sprouts, pretzels and bagels. Cut back on fiber intake to 12 grams a day, less than half the suggested dose.

As a trial, stop all dairy products for a week. Older people often lack the enzyme that digests milk sugar.

It's always good to consider other ailments that can be mistaken for IBS. Celiac disease is an example. It's an inability to digest wheat, barley and rye. Symptoms that raise a red flag indicating that more serious maladies have to be considered are rectal bleeding, nighttime abdominal pain, increasing severity of abdominal pain and weight loss. These are not symptoms of celiac disease.

Are you taking any medicines for IBS? Hyoscyamine controls gastric secretions and slows the passage of food through the tract. Dicyclomine does the same. Loperamide (Imodium) hardens soft and semiliquid stools.

DEAR DR. DONOHUE: My husband is 63 and in excellent health. For nearly a year, we have noticed blood in his semen. It's not coming from me but from him. The doctor said this is nothing to worry about. We then saw a urologist, and the prostate exam was normal. The PSA also was normal. Should we see a urologist at the nearby university's medical school? -- S.M.

ANSWER: The official name for your husband's condition is hematospermia. It freaks everyone out, the man and his partner. It's almost always a benign condition.

If the blood doesn't stop, doctors have to look for signs of infection, bladder cancer, prostate cancer and prostate enlargement. If your husband takes either daily aspirin or a blood thinner like Coumadin, that could explain it. Your husband has been through the mill. If he and you are still worried, then a trip to the medical school's urologist ought to give you peace of mind.

DEAR DR. DONOHUE: Will you direct me to a place where I can get a white noise machine? The ringing in my ear is so bad I can't sleep. -- M.M.

ANSWER: Before resorting to white noise, turn your bedside radio to a station that plays soothing music with few interruptions. If that fails, turn the dial to a position where only static is heard. That might end the ear noise.

White noise is the sound of wind gently blowing, trees rustling or water lapping at the shore. It cancels out the inner-ear ringing of tinnitus for some patients. One distributor of white noise machines is SleepWell Baby Company, reachable at 866-694-1375.

If you have a computer or a friend with one, you'll find many white noise machines with their pictures by using "white noise" as a search phrase.

* * *

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

Dr. Donohue

Dr. Paul Donohue writes a daily column titled "To Your Health" that is syndicated to more than 175 newspapers. The question-and-answer series is one of the oldest health columns in the North America, having first appeared in the 50s. Dr. Donohue took over the series nearly 20 years ago. Dr. Donohue is board-certified in his primary specialty, internal medicine, the specialty that emphasizes diagnosis and non-surgical treatment of illnesses. He also is board-certified in the subspecialty of infectious diseases. He graduated from the University of Michigan Medical School in Ann Arbor, Michigan. He has a master's degree in public health from Tulane University in New Orleans and did advanced work on infectious diseases at the University of California, Davis. After completing medical school, he served two years in the Army Medical Corps and 18 months as battalion surgeon in the 173rd Airborne Brigade-for which he was awarded two Bronze Stars, one of which was for valor during combat. Write to Dr. Paul Donohue at P.O. Box 536475, Orlando, FL 32853-6475.

Last modified: June 23, 2012
All rights reserved. This copyrighted material may not be published without permissions. Links are encouraged.